see also

It's a familiar scenario: public schools with unfilled positions
for speech-language pathologists and audiologists. In Texas, the
shortage of both is statewide. In Mississippi, metropolitan area
schools are well-staffed, but more than 70 rural districts can't
find qualified SLPs.

The associations in both states led successful efforts to enact
student loan forgiveness laws to entice qualified graduates to work
in underserved areas. The legislative victories are only the first
phase of the effort, as neither has funding attached.

"In the current economic climate, it's not unusual for
legislation to be authorized and not appropriated," explained Janet
Deppe, ASHA director of state advocacy. "It can take several years
to get funding. But getting the legislation on the books is a
significant victory. It demonstrates that lawmakers understand the
need to attract and retain qualified speech-language pathology and
audiology professionals."

Texas

In Texas, legislation allows the state to forgive graduate
student loans for SLPs and audiologists who take school-based
positions and for new doctoral-level communication sciences
disorders faculty. Leaders of the Texas Speech-Language-Hearing
Association are pleased with the new legislation, which they began
pursuing 10 years ago.

"Like just about every state in the country, Texas has a
shortage of SLPs in the schools and a shortage of doctoral-level
faculty in our CSD training programs," said Larry Higdon, TSHA
director of governmental relations. After several years of
groundwork, the state legislature filed a $7.5 million loan
repayment bill in 2009 that would forgive up to $30,000 in loans
for 250 new school-based clinicians and up to $45,000 in loans for
10 new doctoral-level faculty in the state's 17 CSD training
programs.

The bill passed both chambers of the Texas legislature and, to
meet legislative deadlines, was attached to another bill and sent
to the governor to sign. On the final day to take action, the
governor vetoed the larger bill, killing the attached loan
repayment legislation.

"We were shocked to read about it in the paper the next day,"
Higdon said. "We had no idea it was at risk. We thought we were
home free."

Undaunted, association leaders worked to have the bill re-filed
in 2011. (The Texas legislature meets every other year.) "But there
was no money that year," Higdon said. "The state had a $30 billion
deficit. We never even got a hearing. But we kept at it. We wanted
to remind the legislators, 'We're still here, we still need your
help.'"

When the 2013 legislative session opened, TSHA leaders applied
the lessons they learned in 2011. They worked with legislators and
appropriations committees to try to get funding, "but no one would
champion it," Higdon said, despite a $2.7 billion budget
surplus.

"We re-filed the identical bill, but with no funding attached to
it," Higdon said. "We added language that allows the loan repayment
program to accept awards, grants and gifts. It passed with no
problem and the governor signed it."

The association is weighing its options for seeking funding for
the bill in the future. In the interim, "we are considering
self-funding, foundation grants, and other sources," Higdon said.
The TSHA board is considering the use of association money; leaders
may ask that surplus funding collected in licensure fees by the
State Board of Examiners for Speech-Language Pathology and
Audiology be used for the loan repayment program.

Pursuing other funding shows the Texas legislature that "we're
willing to put our money where our mouth is," Higdon said. "If we
go to them for money, we have a stronger case if we can say that
we're not just looking for a handout, that we're willing to work
with them to make this happen."

The personnel shortage in Texas has not abated. In 2011, there
were 1,320 unfilled positions in schools, translating into 66,000
students who were unserved or served by clinicians without master's
degrees (Texas allows bachelor's-level clinicians to work in
schools under the supervision of licensed SLPs). About 16 percent
of schools reported vacancies; 75 percent contract with outside
agencies to fill positions, a move that costs $12,000 more per year
per outside provider.

According to a recent poll of students in the state's 17
training programs, the most-cited reason for not pursuing a
master's degree is the cost, Higdon said, adding that "the children
of Texas need this legislation."

Mississippi

For several years, school district superintendents in the more
rural areas of Mississippi had been concerned about their inability
to fill SLP positions. In response, the state board of education
and legislature—unbeknownst to the Mississippi
Speech-Language-Hearing Association—developed and passed a new
licensure law in 2010. The law creates a permanent, renewable "216"
license that allows bachelor's-level speech-language pathology
graduates to provide pediatric articulation treatment in public
schools, "under the guidance/direction of, and in collaboration
with, a master's-level, fully-certified" SLP.

The new license, which took effect July 1, 2013, was designed to
replace the temporary "emergency certificates" and "interim
certificates" school districts would obtain to hire
bachelor's-level clinicians to fill openings, according to Carolyn
Wiles Higdon, 2011 MSHA president. In the 2011–2012 school year,
150 speech-language pathology providers in Mississippi public
schools were working under the temporary, one-year certificates, in
addition to the 800 master's-level SLPs in the state's public
schools.

In response to this new 216 certification, speech-language
pathology leaders requested a statewide interdisciplinary task
force to address the new certification and to approach the rural
shortage more comprehensively. The state's superintendent of
education and Institutions of Higher Learning Board appointed the
task force to:

Work with the state board of education to develop requirements
for the certificate and to develop a training program-specifically
for those holding emergency and interim certificates, who would
have lost their jobs July 1—to meet the requirements.

Work with the state's five undergraduate programs to integrate
the 216 certificate training requirements.

Work with the graduate speech-language pathology training
programs to attract more students through part-time and online
graduate training opportunities.

Address supervision training for licensed, certified SLPs.

Support MSHA's efforts to develop marketing videos to support
recruitment and retention efforts.

Develop the student loan forgiveness program for master's-level
graduates taking jobs in rural public schools.

"The task force debated ways to entice people to rural schools,"
Wiles Higdon said, "and we decided on a loan forgiveness focus,
because graduate education is expensive." MSHA wrote a bill for a
loan forgiveness program that requires students to work in a rural
school for at least two years-one year for every year of graduate
training. "Research tells us that if an SLP stays in a job two or
three years, there's a higher likelihood of that person remaining
in the job," Wiles Higdon explained.

The bill, which calls for up to $35,000 in student loan
forgiveness for 10 students per year, passed the legislature in
2012—unfunded.

"We took our lobbyist's advice and didn't start by asking for
the moon," Wiles Higdon said. "We knew it was going to be a three-
to five-year process. We went back to the legislature in 2013 to
get it funded, but the general approach to the budget this year in
Mississippi was that nothing new was going to be funded. So we will
go back again in 2014 with our data and outcomes."

The law includes only SLPs because, Wiles Higdon said, "We were
new at this, and reacting to the bachelor's-level certificate that
was developed and approved in 2010. Our focus was on how to get
master's-level SLPs into rural school systems in Mississippi."

Despite the funding challenges, Wiles Higdon sees the glass as
half-full. "And our lobbyist is optimistic, too," she says. "We may
go back with a compromise of five students each year for a couple
of years, show the data that the program is working, and then ask
for increased support."

Lessons Learned

Want to try for loan forgiveness legislation in your own
state? Texas leaders offers some pointers.

by Larry Higdon and Cherry Wright

The Texas Speech-Language-Hearing Association helped secure
passage of a student loan repayment bill, designed to help relieve
the shortage of school-based speech-language pathologists, during
the recent legislative session. Here are some key lessons we
learned along the way.

Collect data to support the bill. This is not done overnight!
Plan ahead and be prepared with supporting documentation. TSHA
completed two major surveys of directors of special education and
analyzed the results to have data to support the proposed
legislation. Work with universities in the state to secure
supporting information.

Be sure the state association membership is keenly aware of the
personnel shortage and its negative impact on the profession and
the students who qualify for services. Members must understand the
need for the bill and how it helps fulfill the need. TSHA published
articles about the shortage in its quarterly newsletter for several
years prior to and during the introduction of legislation. The
annual convention included legislative sessions and public school
forums.

Secure legislative liaisons or lobbyists—association volunteers
or employees—who know the legislative process and key legislators
who can introduce and support the bill. They must forge a
relationship with legislative aides and communicate with them
regularly and monitor legislation daily. They should be directly
accountable to a member of the association's Executive Board and
authorized to act on behalf of the association. TSHA has two such
employees—the director of governmental affairs and the legal and
legislative counsel—who report to the vice president for social and
governmental policy.

Organize the legislative communication process so that members
can become actively involved. Communicate with members regularly
(through, for example, e-mail alerts), provide talking points and
an actual script for members to send to their respective
legislators, and identify key members and consumers who testify at
committee hearings. It's also important to identify members who are
relatives or acquaintances of legislators or who provide services
to members of their families-especially legislators on a committee
that reviews the bill—so that they can make personal contacts.

Organize a Legislative Day when members and students converge
on the capitol to educate their respective legislators about the
bill. Prepare talking points and assign a member mentor who can
work with students and walk them through the process. TSHA student
members made quite an impression on legislators! TSHA also sent a
small introductory gift to each legislator (a box of fresh-baked
cookies) on the Legislative Day.

Solicit the help of related professional associations. TSHA has
worked actively with the Texas Council of Administrators in Special
Education for the past 10 years to address the shortage in the
schools. Consequently, the council's president and director of
governmental affairs testified in committee hearings and sent
legislative alerts to their members. TSHA also secured support of
major teacher organizations, which count public-school SLPs as
members.

Be persistent! If you're not successful on the first attempt,
regroup and introduce the bill in a subsequent legislative session.
TSHA introduced the bill in two different legislative sessions
before getting it approved.

Continue to be involved with the legislation once it has
passed. TSHA has formed a committee to provide recommendations to
the Higher Education Board on rules for implementing the
legislation.

Pay Attention to the ‘Invisible Gorillas’

Mississippi leaders heed what's in front of them as they push
for a loan forgiveness bill. Here's what they learned along the
way.

by Carolyn Wiles Higdon

In their book "The Invisible Gorilla" (2010), Christopher
Chabris and Daniel Simons suggest that we do not notice the
important things that are right in front of us—that we think we see
ourselves and the world as they really are, but we're actually
missing a whole lot. When the Mississippi
Speech-Language-Hearing Association decided to propose and advocate
for a loan forgiveness bill, we did not realize some of the most
important things that were right in front of us. We suggest that
the following "invisible gorillas" helped us pursue establishment
of this bill—and we hope they will continue to help us as we pursue
funding.

Collecting the data. Know your numbers before
you develop this type of bill: the number of speech-language
pathology and audiology openings in public schools, the number of
school districts needing either support and/or personnel, the cost
of graduate education in your state, the number of students
completing graduate-level communication sciences and disorders
programs, the number of graduates who remain in your state in CSD
positions and for how long, and the number of graduates who select
public schools versus medical settings.

Meeting with legislators who chair or are
members of key committees.

Teaching students in CSD graduate programs how to
advocate for a bill. Mississippi received a small ASHA
grant to teach students how to advocate for the professions at the
state and federal levels. Our lobbyist took some graduate students
for a "Day at the Capitol" to lobby for the bill, and the
participants then trained their fellow students in grassroots
lobbying. The feedback on this approach was extremely positive, and
we were able to have an impact on many students with this
model.

Working closely with the lobbyist or key
person who will carry the bill's message to lawmakers. Be sure that
the spokesperson has a clear understanding of the professions, the
cost of graduate education and current practice issues.

Educating the state association members about the
bill, including the need for the legislation and its
advantages, and how to advocate without appearing to be
self-serving.

Having discussions with the government relations team
of the state's institutions of higher learning
association (Mississippi's was helpful with
passage). Secure support from key legislative chairmen prior
to the legislative session. Arrange the association's
grassroots advocacy program (for example, a system of quick
response) before the session begins.

Addressing the budget hearings. In
Mississippi, budget hearings begin this month, and we will speak
with the key appropriations chairs and subcommittee chairs to
reinforce the need for funding for our program. The Mississippi
Institutions of Higher Learning's legislative services director
will also support the effort.

Identifying key legislators or politicians in your
state who have family or close friends with communication
disorders. Understand the type of services they have
received in determining how to garner additional support in your
lobbying efforts.

Knowing the profession. I know this
sounds strange, but SLPs and audiologists often become isolated in
their own specialties and niches. As we speak for the profession,
we should not talk about just speech-language pathology or just
audiology. And although we certainly promote our own specialty
areas, it's important that we be able to talk about the breadth and
depth of the professions.

Talking the talk. Just as we need to know the
breadth of the professions, we need to be able to talk about our
academic training models so that legislators and politicians are
aware of extent of our professional training.

Articulating our own clinical and academic knowledge
and training, and how they compare (or don't) to related
professions: Why are SLPs important in classroom academics: Why do
you need a licensed audiologist to recommend your hearing aids? Why
is treatment through early intervention programs by a licensed SLP
important to a high-risk infant? In these changing health care and
educational arenas, we need to do more than "sell" our
profession—we need to be able to explain what we do and why it
requires the skill and knowledge of SLPs and audiologists.

Carolyn Wiles Higdon, EdD, CCC-SLP, cwhigdon@gmail.com, is a professor in the Department of Communication Sciences and Disorders at the University of Mississippi (Oxford), and a clinical associate professor at the UM Medical Center in Jackson. She is ASHA vice president of finance and was 2011 president of the Mississippi Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 10, Issues in Higher Education; 12, Augmentative and Alternative Communication; 13, Swallowing and Swallowing Disorders; 17, Global Issues in Communication Sciences and Related Disorders; and 18, Telepractice.